Category: MACRA

Meaningful use refers to the use of certified electronic health records also known as EHR technology to improve the quality, safety, and efficiency in health organizations and reduce disparities in health records. Its also used to engage patients and their family in order to improve care coordination and the population of public health. And last but not least, meaningful use helps health organizations maintain the privacy and security of patient health information.

Though meaningful use provides these advantages listed above, health organizations have been required to move to Using MACRA instead. MACRA has been presented as more advanced than Meaningful Use with more cost-saving techniques and an increase in patient care efficiency. One of the changes MACRA will make it the adjustment of the fee schedule of providers. MACRA will adjust the fee schedule for all providers upward by 0.5 percent annually from now through 2019. It’s been said that Physicians who are aligned with APM will assume a certain amount of unavoidable risk. Hence, to encourage participation, the APM track will provide 5 percent bonus payments every year from 2019 to 2024 to all newly joining providers. Physicians under this bonus payment structure will only need to adhere to the quality reporting requirements of the APM and will be exempt from the MIPS quality program.

It’s a bit of a challenge to navigate the impact and outcomes of MACRA on the finances of healthcare organizations but even more so, it’s a challenge and some even say the process of Moving from Meaningful Use to MACRAhas been an inconvenience for physicians and healthcare organizations as a whole. Many want to know; how will large integrated healthcare delivery networks predict the impact of a new healthcare law on the system and how will it change Medicare reimbursement? To answer this question requires a comprehensive understanding of the impact of Medicare Access and CHIP Reauthorization Act (MACRA) final rule.

But even with all the challenges moving from meaningful use to MACRA presents, MACRA is still necessary and healthcare organizations have been advised to work towards making the move to MACRA as soon as possible. Below are some reasons why MACRA is necessary.

Without the passage of MACRA, physicians could have been subject to negative payment adjustments that varied from year to year under the Sustainable Growth Rate (SGR). Additional penalties of 11 percent or more would have been applicable in 2019 under the Meaningful Use, Physician Quality Reporting System, and Value-Based Medicine programs. In contrast, under MACRA, with the repeal of the Sustainable Growth Rate, the reimbursement landscape has been stabilized. The largest penalty a physician can experience in 2019 is four percent. MACRA also provides incentives for physicians to develop and participate in different models of health care delivery and payment known as Alternative Payment Models (APMs) which gives them more options.

To make things easier and flow more smoothly for healthcare organizations, MACRA introduced the Quality Payment Program(QPP). This program serves to unify several existing policies to support care improvement for patients by focusing on the better outcomes of patients, decreasing provider burden, and preserving independent clinical practice. And the reduction of cost of care is not left out. The Quality Payment Program also promotes adoption of APMs that align incentives across healthcare stakeholders. It advances existing efforts of Delivery System Reform to ensure a smooth transition to a new system that promotes high-quality, efficient care by unifying these legacy CMS programs to reduce cost and sustain pay parity.

These advantages and more advantages expected to come is why health organizations and Hospitals have worked towards making the transfer from Meaningful Use to MACRA despite the challenges it presents. After all, being current and up to date on all the requirements is always the best policy for any organization.

The Future of MACRA

Instead, what Medicare wanted to see was the healthcare community held responsible for the care they provided. For example: if a patient was treated for a heart attack, received significant care and was discharged from a hospital, but returned to the hospital with a staph infection only a couple weeks later, something probably picked up while staying in the hospital the first time. Obviously, there is no way to prevent every negative scenario from happening to patients, however, patients should have some level of expectation of a positive outcome when they have been treated. This patient doesn’t need to be subjected to tons more testing or pay for care that may have been no fault of his own, alternatively, the hospital would be on the hook for this second go-around of treatment(s). This is specifically where improvement to care and treatment would be ramped up for the healthcare industry, and they can be penalized when there are adverse events with a patient.

Just like a huge aircraft carrier doesn’t make its way out to sea very quickly, you can’t change the way healthcare has been run for decades overnight. Medicare knew that and has been working for decades with many different providers to discover ways that were effective and could be implemented across the board to help meet these two goals. One of the first areas of interest to investigate was the fee-for-service mentality that is and was so common in the healthcare industry. It isn’t a bad way of handling care and treatment for patients, however, it is ripe for deceit, fraud and extra demands on a patient.